Thirty-two patients have been treated with intraclot, pulse-sprayed tissue plasminogen activator, 31 of whom were available. The veins of 12 patients failed to reopen. Three patients could not be adequately heparinized; their veins rapidly reoccluded. The remaining 16 patients were observed on warfarin for a least 2 months. The offending venous access device (VAD) was left in place in four of these patients; three suffered venous reocclusion. VADs were removed from the other ten patients; none of their veins reoccluded. Only two patients developed hypofibrinogenemia; neither hemorrhaged. Five patients had minor bleeding episodes.